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Kidney Health

The kidneys provide a system that filters and cleans blood and excretes the waste products into urine. They also regulate blood pressure as well as the levels of many parts of your blood. It is important to know if your kidneys are healthy because the kidneys, along with the liver, influence the way the body handles different doses of HIV treatments and other drugs.

Diabetes (high sugar levels) and hypertension (high blood pressure) are the most common causes of chronic kidney disease. The rates of both of these conditions are usually significantly higher in people with HIV, and as a result, as people with HIV get older chronic kidney disease may become more common.

Some HIV treatments have also been linked to kidney disease.

Urinary tract infections (UTIs) can also lead to infection and disease of the kidney, particularly if it keeps recurring or is left untreated.

Visit the Kidney Health page of the NAPWHA site for information about urinary tract infections.

What you can do to live well:

  • Make lifestyle changes:
    • Stop smoking.
    • Eat a healthy diet.
    • Keep fit.
    • Maintain a healthy body weight.
    • Drink plenty of water (at least 6-8 glasses a day is recommended by kidney organisations).
  • Have your blood pressure measured – and seek treatment if it is high.
  • Minimise your risk of getting diabetes and control blood glucose if you have diabetes.
  • Take steps to decrease the risk of urinary tract infections (UTI's).
  • Talk to your doctor about having your kidney function tested regularly, despite the lack of any symptoms.

Blood Sugar, Insulin Resistance and Diabetes

Normally blood glucose is distributed to your body’s tissues under the control of insulin. Glucose is then used as ‘fuel’ to meet the energy required by your body. In some cases, this process is disturbed and more insulin is needed for the tissues to take up glucose from the blood. The tissues are said to be ‘resistant’ to insulin, leading to a condition called insulin resistance; which is more common with increased abdominal fat, buffalo hump and HIV-positive people on treatments.

Insulin resistance can lead to Diabetes, a condition where blood glucose becomes quite high.

Some of the factors associated with increased risk for diabetes include:

HIV-positive people are also at higher risk due to some treatments (protease inhibitors), and a higher prevalence of some of the risk factors for diabetes.

Preventing diabetes is important for people with HIV because it leads to increased risk of cardiovascular disease (for which people with HIV are already at increased risk) and in the longer term is associated with the development of a number of diabetes-related conditions.

What you can do to live well:

Preventing diabetes
  • Have your risk assessed and blood glucose levels monitored regularly by your doctor
  • If you are diagnosed with “pre-diabetes” then it is time to act
  • Exercise regularly: either 30 minutes of moderate intensity exercise (brisk walking) at least 5 days per week, or three to four 20-minute sessions of vigorous exercise a week
  • Make changes toward a healthier diet, reduce fat intake, eat a wide range of high fibre foods that have a low ‘glycemic index’

If you are living with diabetes and HIV
  • Exercise regularly. Both aerobic and strength training activities are beneficial
  • Strive to maintain a healthy weight with a diet that limits saturated fats, concentrated sweets, and alcohol. Individualised nutritional plans can be made in conjunction with a registered dietician
  • Stop smoking. This is crucial to reduce the risk of diabetic complications, especially cardiovascular disease
  • Monitor your blood glucose levels, cholesterol and blood pressure regularly
  • Ask your doctor to monitor for diabetes complications such as kidney function, high and low blood sugar
  • Because diabetes increases the risk of foot infections and ulcers, diabetics are advised to check their feet daily for any signs of injury or infection. (The primary care provider should also examine a diabetic client's feet at every visit.) Feet should be carefully washed and dried daily, and socks and supportive footwear are highly recommended. Trimming toenails straight across the tops of the nails can help prevent infections

If you are a woman living with diabetes and HIV
  • Some diabetic women have decreased insulin sensitivity around the time of menstruation, which may lead to difficulty with glucose control; more intensive monitoring may be needed.
Yeast infections are very common, with about three-quarters of all women having one at least once in their lives. Symptoms include vaginal itching and thick, white vaginal discharge. Diabetes, especially poorly controlled diabetes, is a risk factor for yeast infections (i.e. high glucose levels promote yeast attachment and growth, and also interfere with immune responses in the host).
First-line treatment typically involves creams or ointments that are applied directly to the affected areas. Oral treatments are also available but may have interactions with oral medications for diabetes; consultation with a primary care provider is advised. Whether an oral or topical medication is chosen, treatment must include achieving optimal blood glucose control.